Avon Longitudinal Study Of Pregnancy Research Articles

Carriage of antibiotic-resistant bacteria by healthy children.

The frequency of carriage of antibiotic-resistant bacteria in healthy 7- and 8-year-old children in Bristol was studied. Children born in Avon between 1 April 1991 and 31 December 1992, attending the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) 7 year follow-up clinic, formed the study population. Carriage was estimated using mouth and stool samples. None of 105 children on whom information was available had received tetracycline, chloramphenicol, ciprofloxacin or an extended-spectrum cephalosporin in the previous year. Staphylococcus aureus was isolated from mouthwashes from 200 (37.1%) of 539 children sampled. Six (3%) of the isolates were resistant to chloramphenicol or tetracycline and four (2%) were methicillin resistant. Haemophilus spp. were isolated from 369 (72%) of 513 samples and 63 (17%) were ampicillin resistant, 49 (13.3%) were erythromycin resistant and seven (1.9%) were tetracycline resistant. Branhamella catarrhalis was isolated from 333 (74%) of 450 samples. Twenty-eight (8.4%) were erythromycin resistant and 14 (4.2%) strains were tetracycline resistant. Group A beta-haemolytic streptococci were isolated from 17 of 507 children sampled. One (5.9%) was tetracycline resistant. Stool samples were returned from 335 (62%) of 539 children from whom they were requested. Eleven per cent of samples yielded Gram-negative bacilli with high-level resistance to chloramphenicol, which was frequently linked to resistance to ampicillin, spectinomycin and streptomycin. Isolates demonstrating resistance to the third-generation cephalosporin ceftazidime were recovered from 17 subjects (3.2%). Six (35%) of 17 isolates possessed extended-spectrum beta-lactamases. Healthy children carry bacteria resistant to antibiotics to which children are not usually exposed. Resistance to ceftazidime, chloramphenicol and tetracycline may be co-selected by exposure to other antibiotics used in children or may be acquired from family members, pets, other children or food. These results suggest that antibiotic-resistant bacteria are widely disseminated and may be acquired by children before exposure to specific selection pressure.

Maternal employment and the initiation of breastfeeding.

This study examines whether planning to be employed postpartum has an effect on initiation of breastfeeding. Data were collected from questionnaires completed by mothers who were subjects in the prospective, population-based, Avon Longitudinal Study of Pregnancy and Childhood. The mothers of 10,530 full-term singleton infants gave information during pregnancy on their postpartum employment plans and their initial infant feeding methods. Information was also given by 7642 of these mothers on the timing of their postpartum employment plans. Adjusted logistic regression was performed to identify associations between (a) "any" plans to work postpartum and the initiation of breastfeeding, and (b) the timing of the commencement of work postpartum, and the initiation of breastfeeding. A total of 8316 (79%) of the women initiated breastfeeding. The decision to breastfeed was not associated with "any" plans to work postpartum. However, women who planned to commence work prior to 6 wk postpartum were significantly less likely to initiate breastfeeding compared with those not intending to work postpartum. Older, more highly educated women, women who had or were planning to attend childbirth classes, women who were breastfed as infants, women who did not smoke and women who were giving birth to their first child were significantly more likely to initiate breastfeeding. Planning to return to employment prior to 6 wk postpartum reduces the likelihood of initiating breastfeeding. As increasing numbers of mothers are returning to work shortly after the birth of their child, this finding could have implications for maintaining the current level of breastfeeding.

Association between composition of the diet and haemoglobin and ferritin levels in 18-month-old children.

To investigate the associations between composition of the diet at 18 months of age and ferritin and haemoglobin levels. Cross-sectional study. A total of 796 children taking part in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Food and nutrient intakes and haemoglobin and ferritin levels at 18 months. Diet was assessed by a 3-day unweighed food record. A heel-prick capillary blood sample was taken for measurement of ferritin and haemoglobin. Ferritin levels were negatively associated with the amount of cows' milk consumed (r = -0.2462, P < 0.001) and calcium intake (equivalent to a 4-5% drop in ferritin levels for a 100 mg increase in energy-adjusted calcium intake). Haemoglobin levels were positively associated with energy-adjusted vitamin C intake and were higher in children who ate any fruit (P = 0.024) or any vegetables (P = 0.030). The associations between nutrient intakes and ferritin and haemoglobin levels remained on adjustment for socio-demographic factors. The prevalence of low haemoglobin levels was higher in those children who consumed no meat or poultry (28.8% vs 19.0% overall, P = 0.044). Higher levels of milk and dairy product consumption are associated with lower ferritin levels in children of this age, and over-reliance on these foods should be avoided. Fruit and vegetable consumption should be encouraged, and the inclusion of a little meat or fish in the diet of small children is advisable.

Maternal employment and the initiation of breastfeeding

This study examines whether planning to be employed postpartum has an effect on initiation of breastfeeding. Data were collected from questionnaires completed by mothers who were subjects in the prospective, population‐based, Avon Longitudinal Study of Pregnancy and Childhood. The mothers of 10 530 full‐term singleton infants gave information during pregnancy on their postpartum employment plans and their initial infant feeding methods. Information was also given by 7642 of these mothers on the timing of their postpartum employment plans. Adjusted logistic regression was performed to identify associations between (a) “any” plans to work postpartum and the initiation of breastfeeding, and (b) the timing of the commencement of work postpartum, and the initiation of breastfeeding. A total of 8316 (79%) of the women initiated breastfeeding. The decision to breastfeed was not associated with “any” plans to work postpartum. However, women who planned to commence work prior to 6 wk postpartum were significantly less likely to initiate breastfeeding compared with those not intending to work postpartum. Older, more highly educated women, women who had or were planning to attend childbirth classes, women who were breastfed as infants, women who did not smoke and women who were giving birth to their first child were significantly more likely to initiate breastfeeding. Conclusion: Planning to return to employment prior to 6 wk postpartum reduces the likelihood of initiating breastfeeding. As increasing numbers of mothers are returning to work shortly after the birth of their child, this finding could have implications for maintaining the current level of breastfeeding.

Personal exposure to benzene and the influence of attached and integral garages.

Benzene is an air pollutant that is a recognised human carcinogen. An air quality standard has been established for ambient air in the UK to reduce the population's exposure. It has been estimated that about 70% of benzene emissions to air in the UK come from petrol vehicles. A number of studies, including the Avon Longitudinal Study of Pregnancy and Childhood in the UK, have found that benzene concentrations in homes with attached or integral garages tend to be higher than in those without such garages. The present paper reviews these studies and reports a detailed investigation of five homes with either an attached or an integral garage. Indoor and outdoor locations were monitored using diffusive sampling to determine the average benzene concentration over approximately 28 days each month for 18 consecutive months (June 1998-November 1999). For one of these homes, ten years of data had shown the indoor benzene concentration to be consistently higher than outdoors. Personal exposure monitoring of one adult in this home showed that the benzene concentration in the main bedroom was a better predictor of personal exposure than the concentration outdoors. In the homes where a car was regularly parked in the garage, 18-month average benzene concentrations of up to 101.3 micrograms m-3 were measured in the garage, which is more than six times the ambient air quality standard for benzene (16.25 micrograms m-3 running annual average). Mean benzene values in all cars and most of the garages studied exceeded the benzene standard. Mean benzene concentrations in the room above the garage ranged from 3.7 micrograms m-3 in one home, where the car was rarely parked in the garage, to 39.9 micrograms m-3 in another home where a car with high benzene emissions was parked in the garage for six of the 18 months monitored. The mean benzene concentration in the room above the garage in this latter home was nearly 2.5 times the ambient air standard. The study demonstrates that there is a potential for people to have a higher exposure to benzene as a result of living in a home with an attached or integral garage. An understanding of routes of personal exposure is important to develop effective policies to reduce risks to health.

The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months.

The study aimed to document the dietary patterns of infants and determine the development of feeding difficulties as perceived by the mother according to the age at which lumpy solids were introduced into the diet. Information was collected from a geographically representative population of 9360 mothers of infants born in 1991/92, part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Self-completion questionnaires enquiring about the foods and drinks consumed by the infant and any difficulties experienced by the mothers in feeding her child at both 6 months and 15 months of age were collected. Infants were divided into three groups based on the age at which they were first introduced to 'lumpy' solids: 10.7% were introduced before 6 months of age, 71.7% were introduced between 6 and 9 months and 17.6% were introduced after 10 months of age. The foods eaten by those introduced before 6 months and after 10 months were compared to those introduced between 6 and 9 months. Behaviours and problems as reported by the mother were also assessed. Those infants who were introduced to lumpy solids at the earliest ages consumed a greater variety of family foods at the age of 6 months, while those introduced at 10 months or later had been given fewer solids of all types by 6 months of age and at 15 months were significantly less likely to be having family foods when compared to those introduced between 6 and 9 months. At each age, those introduced late (10 months or older) to lumps were more difficult to feed and had more definite likes and dislikes. A significant difference was observed in the variety of foods given to infants at both 6 and 15 months according to the age at which they began to have lumps in their food, and feeding difficulties were more likely to occur when lumps were introduced at or after 10 months of age.

Associations between dietary intakes and blood cholesterol concentrations at 31 months.

The initial stages of atherosclerosis have been shown to occur in children as young as 3. Elevated total and LDL cholesterol concentrations and low HDL concentrations are a well-established risk factor for atherosclerosis. The objective of this study was to investigate the dietary determinants of blood lipid concentrations at 31 months of age. A randomly selected group of children (214 boys, 175 girls) in south-west England forming part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) cohort. Three-day dietary records were obtained at 18 months. At 31 months a non-fasting blood sample was taken and analysed for total and HDL cholesterol and triglyceride, and measures of height and weight were taken. Among boys, total cholesterol concentrations were positively associated with the intake of total fat (r=0.209, P=0.002) and saturated fatty acids (r=0.211, P=0.002). Among girls, HDLC was positively associated with energy intake (r=0.204, P=0.018), and negatively associated with intakes of polyunsaturated fat, saturated fat and sugar in multivariate analysis. There were no associations between the intakes of non-starch polysaccharides (fibre) or dietary cholesterol and total or HDL cholesterol concentrations in either sex. Among boys, higher intakes of breakfast cereals were associated with lower total cholesterol (r=-0.187, P=0.008). Among girls, higher intakes of biscuits and meat and meat products were associated with higher HDLC concentrations. These data suggest that the dietary determinants of blood lipid concentrations differ between boys and girls. Reducing saturated fat intake in boys would be likely to lead to an improvement in blood lipid profiles. In this study there is no evidence to suggest that an increase in the intake of polyunsaturated fat by pre-school children would result in improved blood lipid profiles.

ALSPAC--the Avon Longitudinal Study of Parents and Children. I. Study methodology.

ALSPAC (The Avon Longitudinal Study of Parents and Children, formerly the Avon Longitudinal Study of Pregnancy and Childhood) was specifically designed to determine ways in which the individual's genotype combines with environmental pressures to influence health and development. To date, there are comprehensive data on approximately 10,000 children and their parents, from early pregnancy until the children are aged between 8 and 9. The study aims to continue to collect detailed data on the children as they go through puberty noting, in particular, changes in anthropometry, attitudes and behaviour, fitness and other cardiovascular risk factors, bone mineralisation, allergic symptoms and mental health. The study started early during pregnancy and collected very detailed data from the mother and her partner before the child was born. This not only provided accurate data on concurrent features, especially medication, symptoms, diet and lifestyle, attitudes and behaviour, social and environmental features, but was unbiased by parental knowledge of any problems that the child might develop. From the time of the child's birth many different aspects of the child's environment have been monitored and a wide range of phenotypic data collected. By virtue of being based in one geographic area, linkage to medical and educational records is relatively simple, and hands-on assessments of children and parents using local facilities has the advantage of high quality control. The comprehensiveness of the ALSPAC approach with a total population sample unselected by disease status, and the availability of parental genotypes, provides an adequate sample for statistical analysis and for avoiding spurious results. The study has an open policy in regard to collaboration within strict confidentiality rules.

Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology.

To assess the ability of simple definitions of BMI to successfully screen for children with high body fatness. We determined the sensitivity and specificity of the body mass index (BMI) by testing its ability to correctly identify children with high body fat percentage. Receiver operator characteristic (ROC) analyses were carried out using the top 5% of body fat percentage to define children as obese (true positives). Representative sample of 4175 7 y-old (88-92 month-old) children (2120 boys; 2055 girls) participating in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). The current obesity definition based on BMI (95th centile) had moderately high sensitivity (88%) and high specificity (94%). Sensitivity and specificity did not differ significantly between boys and girls. The ROC analysis showed that lower cut-offs applied to the BMI improved sensitivity with no marked loss of specificity: the optimum combination of sensitivity (92%) and specificity (92%) was at a BMI cut-off equivalent to the 92nd centile. Sensitivity of BMI using the new International Obesity Task Force (IOTF) cut-off for obesity was much lower, and differed significantly (P < 0.001) between boys (46%) and girls (72%). Screening for childhood obesity using the BMI is specific, and can have moderately high sensitivity if an appropriate cut-off is chosen. New recommendations based on the IOTF approach to defining childhood obesity are associated with lower sensitivity, and sensitivity differs between boys and girls.

Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

To assess the prevalence of pacifier and digit sucking at 15 months of age and to investigate whether this habit adversely affects the health of 18 month old infants. Data collected via self-completion questionnaires from mothers forming part of the prospective, population based Avon Longitudinal Study of Pregnancy and Childhood. The mothers of 10006 infants gave information on their child's use of a pacifier and of digit sucking at 15 months of age and the presence of specific health symptoms at 18 months of age. Adjusted logistic regression was performed to identify any statistically significant associations between pacifier use, digit sucking or a combination of the two with possible infection. 36.3% of infants sucked a pacifier, 21. 3% their thumb or finger and 2.7% sucked both at 15 months. Statistically significant differences were observed among various socio-demographic variables. Mothers were more likely to give their child a pacifier if they were younger, had lower levels of education, experienced greater financial difficulties or lived in council housing (compared to owned/mortgaged). The opposite was apparent for digit suckers. After allowing for these possible confounding factors, pacifier users had a higher incidence of earache and colic compared to children with no sucking habit, however digit suckers had a lower incidence of these symptoms. Children who sucked both were significantly more likely to have reported wheezing, earache, and poor health in the past month. Significantly different sociodemographic characteristics were observed with pacifier suckers compared to those who sucked their thumb or finger. It is almost impossible to attribute the direction of causality between infection and a sucking habit. Further and more detailed studies are needed before any recommendations can be made based on the statistically significant associations found as they are unlikely to be of major clinical significance.

Distribution of accidents, injuries, and illnesses by family type. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

To investigate whether family type and psychosocial risks indexed by family type were systematically associated with differences in health outcomes in children. The study is based on a longitudinal, prospective study of a large (n = approximately 10 000) community sample of families, the Avon Longitudinal Study of Pregnancy and Childhood. Frequency of accidents, illnesses, and medical interventions. At 2 years of age, children in single-parent and stepfamilies were disproportionately likely to experience accidents and receive medical treatment for physical illnesses. In addition, children in single-parent families and stepfamilies were more likely to be hospitalized or receive attention from a hospital doctor for an injury or illness. Exposure to psychosocial risks also were elevated in single-parent families and stepfamilies, compared with intact or nonstepfamilies, and these factors primarily accounted for the connection between family type and children's physical health. The consequences of family transitions on children's health extend beyond traditional mental health and behavioral outcomes and include accident proneness, illness, and receipt of medical attention. The mediating processes are not entirely attributable to social class differences connected to family type and may instead be associated with a range of psychosocial risks that are more frequently found in single-parent families and stepfamilies, compared with intact or nonstepfamilies. Prevention and intervention efforts directed toward children at risk for poor behavioral and mental health adjustment secondary to family disruption should consider children's physical health and health-related behaviors.

The relationship between otitis media with effusion and contact with other children in a British cohort studied from 8 months to 3 1/2 years

Objective: It is generally acknowledged that otitis media with effusion is more prevalent among children attending grouped day care. This study aimed to refine this by determining the relationships with the numbers of children at the place of day care, the age of the child and the number of siblings he/she had. Methods: ALSPAC (the Avon Longitudinal Study of Pregnancy and Childhood) is a population based longitudinal study starting early in pregnancy and following the children throughout their lives. Nested within this study, a randomly selected group of 1590 children, the Children in Focus, were invited to attend a clinic for hands on examinations. Tympanometry was carried out at ages 8, 12, 18, 25, 31, 37 and 43 months of age. Bilateral otitis media with effusion (OME) was identified if both ears showed a flat trace. Multi-level modelling with logistic regression adjusted for a number of social and environmental influences. Results: Of the 1590 children invited to the 8-month clinic, 300 (19%) were excluded from the analysis because of failure to attend or because of missing data. The analyses were based on 1290 children. The prevalence of bilateral OME decreased with age, from 24.6% at 8 months to 11.9% at 43 months. Children with older siblings and those attending day care with four or more other children were at an increased risk of OME. The adjusted odds ratios (AOR) were 1.52 (95% confidence interval [CI]=1.23, 1.88) and 1.36 (95% CI=1.02, 1.82), respectively. The risk associated with older siblings declined with age and by 3 years these children were no longer more likely to have OME than children with no older siblings. No such interaction with age was found for children in group day care and these children continued to be at an increased risk over the entire age period of the study. There was no increased risk associated with day care when no other children attended (AOR=1.18, 95% CI=0.88, 1.58) or when one to three others were present (AOR=1.10, 95% CI=0.85, 1.42). Although there was no relationship with the number of hours spent in day care, children who had started attending group care with four or more other children before 9 months of age did have an increased risk compared with children starting later AOR=1.88, 95% CI=1.12, 3.14. Conclusions: These results provide evidence that early contact with other children increases the risk of OME and that children attending day care with four or more other children remain at an increased risk of OME at least until 3 1/2 years.

The frequency of otitis media with effusion in British pre-school children: a guide for treatment. ALSPAC Study Team.

Data on the prevalence of otitis media with effusion (OME) as shown by serial tympanometry is presented for young children during the first 5 years of life. The children were participants in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC); a randomly selected 10% (n = 1400) of whom were selected for examination at ages 8, 12, 18, 25, 31, 37, 43, 49 and 61 months. Whilst sex had no effect, there was a decrease in prevalence of OME with increasing age. There was a marked seasonal effect on the prevalence of OME. Bilateral and unilateral OME were significantly more prevalent in the winter than in the summer months (36.6% in February in children aged 8 months compared with 16% at 61 months and 16.4% in August in children aged 8 months compared with 3.1% at 61 months). The results form an important background against which to assess both the results of screening and also the indications for surgical treatment.

Association between postnatal catch-up growth and obesity in childhood: prospective cohort study

Objective: To identify predictors of postnatal catch-up growth from birth to two years and its relation to size and obesity at five years.Design: Regional prospective cohort study.Setting: Avon longitudinal study...

Types of drinks consumed by infants at 4 and 8 months of age: sociodemographic variations

Aim To investigate the variations in sociodemographic characteristics of mothers in relation to the types of milk and supplementary drinks consumed by their infants at 4 and 8 months of age. Study design The carers of a randomly chosen population sample of over 1000 infants from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) were asked to record all foods and drinks consumed by the child in a 24-h period at both 4 and 8 months of age. Self-completion postal questionnaires were used to ascertain sociodemographic characteristics of the mothers and their infants. Methods Significant differences in the types of milks and supplementary drinks consumed within sociodemographic groups were identified. Infants were also grouped according to the types of milks they were receiving at each age and further differences in sociodemographic characteristics were investigated. Results Highly significant differences existed among various sociodemographic characteristics with regard to the types of drinks used at both ages. Maternal educational level was the most influential of the sociodemographic variables in explaining the differences in consumption of all types of drinks given at 4 months, in particular for breast milk use. Maternal age was also significantly associated with breast feeding. The use of fruit drinks was significantly associated with the presence of older siblings in the family and the use of herbal drinks with the duration of breast feeding. At 8 months of age maternal educational level was again the most highly associated of the sociodemographic variables, being significantly associated with the use of most of the drinks. The presence of older siblings also had a significant independent effect as did duration of breast feeding. The feeding of cows’ (or animal) milk as a main drink at 8 months, contrary to recommendation, was most likely in the group of mothers with vocational education, those in council accommodation, those with two or more children and those with difficulty affording food. Conclusion We have identified certain characteristics of mothers who were more likely than others not to follow current recommendations on infant feeding. The educational level of mothers appears to be of major significance in the choices made about the types of drinks given to infants. It may be possible to target information about infant feeding to certain groups of mothers thus improving weaning patterns.

A maternal vegetarian diet in pregnancy is associated with hypospadias. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

To investigate the possible role of the maternal diet, particularly vegetarianism and consumption of phytoestrogens, in the origin of hypospadias, which is reported to be increasing in prevalence. Detailed information was obtained prospectively from mothers, including previous obstetric history, lifestyle and dietary practices, using structured self-completed questionnaires during pregnancy. Previously recognized associations with environmental and parental factors were examined, focusing particularly on the hypothesized hormonal link. Multivariate logistic regression was used to identify independent associations. Of 7928 boys born to mothers taking part in the Avon Longitudinal Study of Pregnancy and Childhood, 51 hypospadias cases were identified. There were no significant differences in the proportion of hypospadias cases among mothers who smoked, consumed alcohol or for any aspect of their previous reproductive history (including the number of previous pregnancies, number of miscarriages, use of the contraceptive pill, time to conception and age at menarche). Significant differences were detected for some aspects of the maternal diet, i.e. vegetarianism and iron supplementation in the first half of pregnancy. Mothers who were vegetarian in pregnancy had an adjusted odds ratio (OR) of 4.99 (95% confidence interval, CI, 2.10-11.88) of giving birth to a boy with hypospadias, compared with omnivores who did not supplement their diet with iron. Omnivores who supplemented their diet with iron had an adjusted OR of 2.07 (95% CI, 1.00-4.32). The only other statistically significant association for hypospadias was with influenza in the first 3 months of pregnancy (adjusted OR 3.19, 95% CI 1.50-6.78). As vegetarians have a greater exposure to phytoestrogens than do omnivores, these results support the possibility that phytoestrogens have a deleterious effect on the developing male reproductive system.

Multivariate analysis of diet among three-year-old children and associations with socio-demographic characteristics. The Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) Study Team.

The study of the whole diet in combination rather than the consumption of individual food items or the intake of specific nutrients could be enlightening. This has been previously performed using principal components analysis (PCA) on adult diets but not on those of children. The frequency of consumption of a range of food items was recorded for 10,139 3-y-old children by their mothers using self-completion postal questionnaires. These children form part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). PCA was performed to identify individual dietary types which were then related to various socio-economic and demographic characteristics. Four distinct dietary components were obtained explaining 23.5% of the total variation in the sample, and the socio-demographic characteristics of the sample were related to them. The first represented a diet based on convenience foods and was associated with younger, less educated mothers and the presence of older siblings. The second was associated with a high consumption of foods currently considered to be healthy and was particularly related to vegetarian mothers and higher education levels. The third component described the established British 'meat and two veg' diet and was associated with girls and children with no older siblings, while the fourth had high loadings for snack and finger foods and was related to socially advantaged conditions and the presence of older siblings. Identifiable groups of mothers were associated with feeding their child each of the four dietary types, supporting the hypothesis that social, demographic and lifestyle factors relating to the mother have an influence on the early eating patterns of children. This analysis will form a basis for the future study of various childhood outcomes including growth, health and development. University of Bristol European Journal of Clinical Nutrition (2000) 54, 73-80

Differences between infants and adults in the social aetiology of wheeze. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

OBJECTIVES: To compare the relation between relative deprivation, its associated social risk factors and the prevalence of wheeze in infancy and in adulthood. DESIGN: A cross sectional population study. SETTING:...

Does employment improve the health of lone mothers?

In Britain the government is currently proposing legislation that will encourage welfare recipients to gain employment. A central tenet of this ‘welfare to work’ policy is that employment will not only reduce the poverty of welfare recipients, but also improve their health. This research assessed the extent to which the movement from ‘welfare to work’ is likely to benefit the mental and physical health of lone mothers with preschool children. The sample was 719 lone mothers and a comparison group of 8779 women with partners drawn from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Data collected by self completion questionnaire at 33 months postpartum provided information about average weekly take home family income and the mother’s employment status. The health outcomes measured were general well being, both minor and major depression (using the Edinburgh Postnatal Depression Scale), self report of respiratory symptoms (cough/cold, wheeze, influenza) from 18–33 months postpartum and self report of symptoms common in the childbearing years (backache, haemorrhoids) also from 18–33 months postpartum. Lone mothers who were not employed were the poorest group in the sample; 94% of this group (402) had a family income of less than £200 per week, compared with 72% (188) of lone mothers who were employed, 25% (905) of partnered women who were not employed and 12% (466) of partnered women who were employed. Lone mothers were significantly more likely than women with partners to report poorer well being ( χ 2=11.7, df=3, P=0.01), to have a major depressive disorder ( χ 2=92.6, df=1, P=0.0001) and to report wheeze ( χ 2=31.1, df=1, P=0.0001), but significantly less likely to report cough/cold ( χ 2=9.9, df=1, P=0.0001) or haemorrhoids ( χ 2=16.6, df=1, P=0.0001). Lone mothers who were unemployed and living on less than £100 per week were significantly more likely to be depressed ( χ 2=3.9, df=1, P=0.05) than those who were employed and living on £200 or more per week, and significantly less likely to report cough/cold ( χ 2=3.8, df=1, P=0.05). Logistic regression analyses showed no significant independent association between employment and better health for lone mothers. Rather, when compared with lone mothers who were not working, those who were employed were more likely to report minor respiratory symptoms such as cough/cold (OR=1.51, 95% CI=1.00,2.31). Overall, the results suggested that the movement from ‘welfare to work’ is unlikely to improve the health of lone mothers.

Pertussis vaccination and wheezing illnesses in young children: prospective cohort study

Objectives: To examine the relation between pertussis vaccination and the prevalence of wheezing illnesses in young children.Design: Prospective cohort study.Setting: Three former health districts comprising Avon Health Authority.Subjects: 9444 of...